Comprehensive Therapy

, Volume 26, Issue 4, pp 276–282

The dietary prevention and treatment of coronary heart disease in the new millennium

  • Michel de Lorgeril
  • Patricia Salen
Original Article


Dietary changes can reduce the risk of coronary artery disease by 50%–70%. By understanding the mechanism, we can begin explaining why coronary heart disease has been the leading cause of mortality in most industrialized nations over the last century.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Keys A, et al. Seven countries. a multivariate analysis of death and coronary heart disease. A Commonwealth Fund Book Cambridge, Harvard University Press. 1980:1–381.Google Scholar
  2. 2.
    Sans S, Kesteloot H, Kromhout D. The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Heart J. 1997;18:1231–1248.Google Scholar
  3. 3.
    Serra-Majem L, Ferro-Luzzi A, Bellizzi M, Salleras L. Nutrition policies in Mediterranean Europe. Nutr Rev. 1997;55:S42-S57.PubMedCrossRefGoogle Scholar
  4. 4.
    Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61 (Suppl):1402S-1406S.PubMedGoogle Scholar
  5. 5.
    de Lorgeril M. Mediterranean diet in the prevention of coronary heart disease. Nutrition. 1998;14:55–57.PubMedCrossRefGoogle Scholar
  6. 6.
    de Lorgeril M, Salen P, Monjaud I, Delaye J. The diet heart hypothesis in secondary prevention of coronary heart disease. Eur Heart J. 1997;18:14–18.CrossRefGoogle Scholar
  7. 7.
    Singh RB, Rastogi SS, Verma R, et al. Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up. BMJ. 1992;304:1015–1019.PubMedCrossRefGoogle Scholar
  8. 8.
    de Lorgeril M, Renaud S, Mamelle N, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343:1454–1459.PubMedCrossRefGoogle Scholar
  9. 9.
    Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial. Lancet. 1989;334:757–761.CrossRefGoogle Scholar
  10. 10.
    Key TJ, Thorogood M, Appleby PN, Burr ML. Dietary habits and mortality in 11000 vegetarians and health conscious people: results of a 17 year follow yp. BMJ. 1996;313:775–779.PubMedGoogle Scholar
  11. 11.
    Albert CM, Hennekens CH, O'Donnell CJ, et al. Fish consumption and risk of sudden death. JAMA. 1998;279:23–28.PubMedCrossRefGoogle Scholar
  12. 12.
    Daviglus ML, Stamler J, Orencia AJ, et al. Fish consumption and the 30-year risk of fatal myocardial infarction. N Engl J Med. 1997;336:1046–1053.PubMedCrossRefGoogle Scholar
  13. 13.
    Robinson K, Arheart K, Refsum H, et al. Low circulating folate and vitamin B6 concentrations: risk factors for stroke, peripheral vascular disease and coronary heart disease. European COMAC Group. Circulation. 1998;97:437–443.PubMedGoogle Scholar
  14. 14.
    Wever RM, Lüscher TF, Cosentino F, Rabelink TJ. Atherosclerosis and the two faces of endothelial nitric oxide synthase. Circulation. 1998;97:108–112.PubMedGoogle Scholar
  15. 15.
    de Lorgeril M. Dietary arginine in prevention of cardiovascular diseases. Cardiovasc Res. 1998;37:560–563.PubMedCrossRefGoogle Scholar
  16. 16.
    de Lorgeril M, Salen P, Martin JL, et al. Effect of a Mediterranean-type of diet on the rate of cardiovascular complications in coronary patients. Insights into the cardioprotective effect of certain nutriments. J Am Coll Cardiol. 1996;28:1103–1108.PubMedCrossRefGoogle Scholar
  17. 17.
    de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors and the rate of cardiovascular complications after myocardial infarction. Final report of the Lyon Diet Heart Study. Circulation. 1999;99:779–785.PubMedGoogle Scholar
  18. 18.
    de Lorgeril M, Salen P, Caillat-Vallet E, Hanauer MT, Barthelemy JC, Mamelle N. Control of bias in dietary trial to prevent coronary recurrences. The Lyon Diet Heart Study. Eur J Clin Nutr. 1997;51:116–122.PubMedCrossRefGoogle Scholar
  19. 19.
    de Lorgeril M, Salen P, Martin JL, Monjaud I, Boucher P, Mamelle N Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch Intern Med. 1998;158:1181–1187.PubMedCrossRefGoogle Scholar
  20. 20.
    de Lorgeril M, Salen P. Mediterranean diet in secondary prevention of coronary heart disease. Aust J Nutr Diet. 1998; 55(Suppl):16S-20S.Google Scholar
  21. 21.
    Fraser G. Diet and coronary heart disease: beyond dietary fats and low-density-lipoprotein cholesterol. Am J Clin Nutr. 1994;59(Suppl):1117S-1123S.PubMedGoogle Scholar
  22. 22.
    Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med. 1999;340:115–126.PubMedCrossRefGoogle Scholar
  23. 23.
    de Lorgeril M, Latour JG. Leukocytes, thrombosis and unstable angina (Letter). N Engl J Med. 1987;316:1161.PubMedGoogle Scholar
  24. 24.
    Moreno PR, Falk E, Palacios JF, Newell JB, Fuster, V, Fallon JT. Macrophage infiltration in acute coronary syndromes. Implications for plaque rupture. Circulation. 1994;90:775–778.PubMedGoogle Scholar
  25. 25.
    Van der Wal AC, Becker EC, Van der los DS, Das PK. Site of intimal rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology. Circulation. 1994;89:36–44.PubMedGoogle Scholar
  26. 26.
    de Lorgeril M, Basmadjian A, Lavallée M, et al. Influence of leukopenia on collateral flow, reperfusion flow, reflow ventricular fibrillation, and infarct size in dogs. Am Heart J. 1989;117:523–532.PubMedCrossRefGoogle Scholar
  27. 27.
    Kuzuya T, Hoshida S, Suzuki K, et al. Polymorphonuclear leukocyte activity and ventricular arrhythmia in acute myocardial infarction. Am J Cardiol. 1988;62:868–872.PubMedCrossRefGoogle Scholar
  28. 28.
    Liuzzo G, Biasucci LM, Gallimore JR, et al. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994;331:417–424.PubMedCrossRefGoogle Scholar
  29. 29.
    Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witztum JL. Beyond cholesterol: modifications of low-density lipoproteins that increase its atherogenicity. N Engl J Med. 1989;320:915–24.PubMedCrossRefGoogle Scholar
  30. 30.
    Hodis HN, Kramsch DM, Avogaro P, et al. Biochemical and cytotoxic characteristics of an in vivo circulating oxidized low density lipoprotein (LDL-). J Lipid Res. 1994;35:669–677.PubMedGoogle Scholar
  31. 31.
    Juul K, Nielsen LB, Munkholm K, Stender S, Nordestgaard BG. Oxidation of plasma low-density lipoprotein accelerates its accumulation in the arterial wall in vivo. Circulation. 1996;94:1698–1704.PubMedGoogle Scholar
  32. 32.
    Holvoet P, Vanhaecke J, Janssens S, Van de Werf F, Collen D. Oxidized LDL and malondialdehyde-modified LDL in patients with acute coronary syndromes and stable coronary artery disease. Circulation. 1998;98:1487–1494.PubMedGoogle Scholar
  33. 33.
    Chancerelle Y, de Lorgeril M, Viret R, et al. Increased lipid peroxidation in cyclosporin-treated heart transplant recipients. Am J Cardiol. 1991;68:813–816.PubMedCrossRefGoogle Scholar
  34. 34.
    Parks EJ, German JB, Davis PA, et al. Reduced oxidative susceptibility of LDL from patients participating in an intensive atherosclerosis treatment program. Am J Clin Nutr. 1998;68:778–785.PubMedGoogle Scholar
  35. 35.
    Louheranta AM, Porkkala-Sarataho EK, Nyyssönen MK, Salonen RM, Salonen JT. Linoleic acid intake and susceptibility of very-low-density and low-density lipoproteins to oxidation in men. Am J Clin Nutr. 1996;63:698–703.PubMedGoogle Scholar
  36. 36.
    Bonanome A, Pagnan A, Biffanti S, et al. Effect of dietary monounsaturated and polyunsaturated fatty acids on the susceptibility of plasma low density lipoproteins to oxidative modification. Arterioscl Thromb. 1992;12:529–533.PubMedGoogle Scholar
  37. 37.
    Tsimikas S, Reaven PD. The role of dietary fatty acids in lipoprotein oxidation and atherosclerosis. Curr Opin Lipidol. 1998;9:301–307.PubMedCrossRefGoogle Scholar
  38. 38.
    Tsimikas S, Philis-Tsimikas A, Alexopoulos, S, et al. LDL isolated from Greek subjects on a typical diet or from American subjects on an oleate-supplemented diet induces less monocyte chemotaxis and adhesion when exposed to oxidative stress. Arterioscler Thromb Vasc Biol. 1999;19:122–130.PubMedGoogle Scholar
  39. 39.
    Jialial I, Grundy SM. Effect of combined supplementation with alpha-tocopherol, ascorbate and beta-carotene on low density lipoprotein oxidation. Circulation. 1993;88:2780–2786.Google Scholar
  40. 40.
    Miller III ER, Appel LJ, Risby TH. Effect of dietary patterns on measures of lipid peroxidation. Results of a randomized clinical trial. Circulation. 1998;98:2390–2395.PubMedGoogle Scholar
  41. 41.
    Felton CV, Crook D, Davies MJ, Oliver MF. Dietary polyunsaturated fatty acids and composition of human aortic plaques. Lancet. 1994;344:1195–1196.PubMedCrossRefGoogle Scholar
  42. 42.
    Rapp JH, Connor WE, Lin DS, Porter JM. Dietary eicosapentaenoic acid and docosahexaenoic acid from fish oil. Their incorporation into advanced human atherosclerotic plaques. Arterioscler Thromb. 1991;11:903–911.PubMedGoogle Scholar
  43. 43.
    Lee TH, Hoover RL, Williams JD, et al. Effect of dietary enrichment with eicosapentaenoic and docosahexaenoic acids on in-vitro neutrophil and monocyte leukotriene generation and neutrophil function. N Engl J Med. 1985;312:1217–1224.PubMedCrossRefGoogle Scholar
  44. 44.
    Trichopoulou A, Kouris-Blazos A, Wahlqist ML, et al. Diet and overall survival in elderly people. BMJ. 1995;311:1457–1460.PubMedGoogle Scholar
  45. 45.
    Sandker GW, Kromhout D, Arvanis C, et al. Serum cholesteryl ester fatty acids and their relation with serum lipids in elderly men in Crete and The Netherlands. Eur J Clin Nutr. 1993;47:201–208.PubMedGoogle Scholar
  46. 46.
    Simopoulos AP, Norman HA, Gillapsy JE, Duke JA. Common purslane: a source of omega-3 fatty acids and antioxidants. J Am Coll Nutr. 1992;11:374–382.PubMedGoogle Scholar
  47. 47.
    Simopoulos AP, Salem N. n-3 fatty acids in eggs from rangefed Greek chickens (Letter). N Engl J Med. 1989;321:1412.PubMedCrossRefGoogle Scholar
  48. 48.
    Kromhout D, Bosschieter EB, De Lezenne Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med. 1985;312:1205–1209.PubMedCrossRefGoogle Scholar
  49. 49.
    Stone NJ. Fish consumption, fish oil, lipids and coronary heart disease. Circulation. 1996;94:2337–2340.PubMedGoogle Scholar
  50. 50.
    Kromhout D. Fish consumption and sudden cardiac death. JAMA. 1998;279:65–66.PubMedCrossRefGoogle Scholar
  51. 51.
    Billman GE, Kang JX, Leaf A. Prevention of sudden cardiac death by dietary pure omega-3 polyunsaturated fatty acids in dogs. Circulation. 1999;99:2452–2457.PubMedGoogle Scholar
  52. 52.
    Hu FB, Stampfer MJ, Manson JE, et al. Dietary intake of alpha-linolenic acid and risk of fatal ischemic heart disease among women. Am J Clin Nutr. 1999;69:890–897.PubMedGoogle Scholar
  53. 53.
    GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999;354:447–455.CrossRefGoogle Scholar
  54. 54.
    Boushey CJ, Beresford SA, Omenn GS, Motulsky AG. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA. 1995;274:1049–1057.PubMedCrossRefGoogle Scholar
  55. 55.
    Pancharuniti N, Lewis CA, Sauberlich HE, et al. Plasma homocysteine, folate and vitamin B12 concentrations and risk for early-onset coronary heart disease. Am J Clin Nutr. 1994;59:940–948.PubMedGoogle Scholar
  56. 56.
    Morrison HI, Schaubel D, Desmeules M, Wigle DT. Serum folate and risk of fatal coronary heart disease. JAMA. 1996;275:1893–1896.PubMedCrossRefGoogle Scholar
  57. 57.
    Verhaar MC, Wever RM, Kastelein JJ, van Dam T, Koomans HA, Rabelink TJ. 5-Methyltetrahydrofolate, the active form of folic acid, restores endothelial function in familial hypercholesterolemia. Circulation. 1998;97:237–241.PubMedGoogle Scholar
  58. 58.
    Matthews RG, Kaufman S. Characterization of the dihydropterin reductase activity of pig liver methylenetetrahydrofolate reductase. J Biol Chem. 1980;255:6014–6017.PubMedGoogle Scholar
  59. 59.
    Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastation on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996; 335:1001–1009.PubMedCrossRefGoogle Scholar
  60. 60.
    The Long Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349–1357.CrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2000

Authors and Affiliations

  • Michel de Lorgeril
    • 1
  • Patricia Salen
    • 1
  1. 1.Départment des Sciences de la VieCentre National de la Recherche Scientifique (CNRS)ParisFrance
  2. 2.Laboratoire du Stress Cardiovasculaire et Pathologies AssociéesUFR de Médecine et PharmacieLa Tronche (Grenoble)France

Personalised recommendations